Provider Demographics
NPI:1194358150
Name:COASTAL VOICE & DYSPHAGIA DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:COASTAL VOICE & DYSPHAGIA DIAGNOSTICS, LLC
Other - Org Name:COASTAL PLAIN THERAPY & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, SPEECH-LANGUAGE PATHOLOGISTS
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:912-687-1026
Mailing Address - Street 1:PO BOX 2356
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-2356
Mailing Address - Country:US
Mailing Address - Phone:912-687-1026
Mailing Address - Fax:
Practice Address - Street 1:15 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5306
Practice Address - Country:US
Practice Address - Phone:912-687-1026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL VOICE & DYSPHAGIA DIAGNOSTICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-18
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation